Glossary

Insuring Your Family

Your health plan probably gives you the option of insuring your immediate family, too. Here's what you need to know to get your family covered.

Single Plan or Family Plan?

This one may sound like a no-brainer. If you're single, you choose a single plan and if you have a family, you choose the family plan, right? Well, probably. But there are other factors to consider.

Basically, single plans cover one person and family plans cover one person plus their spouse and/or children, also known as dependents. Both offer the same benefits, but differ in the number of people they cover and at what cost. Take a look at the situations below.

Living Single

This one is pretty straightforward – if you’re unmarried and don’t have children, choose the single plan. (Some health plans you get through your job may cover domestic partners under a family plan.)

Happily (we hope) Married

If you’re married, you might choose either a single or family plan. Some insurers also offer a two-party plan. Your choice could depend on a number of things. You might even want to consider dual coverage.

If you don’t have health insurance, the best choice is probably to join your spouse’s plan.

If you both have health insurance, it might be cheaper for each of you to have a single plan. This way, you can both keep your doctors (which might not be possible if your spouse has a different health insurer).

When you both have health insurance and a family or two-party plan makes the most sense for you, you’ll need to decide whose plan to choose. Here are some important things to consider:

Benefitschart

It all comes down to money and personal preference on the care you want. Compare plans to decide whether a single or family plan will maximize your benefits.

Civil Unions

If you’re in a civil union, check with your employer to see if their policies allow you to cover your partner under your family plan.

Growing Family

Most family plans will cover your children up to age 26. (Don’t try throwing your brother or dog on there – it ain’t gonna work.) Check with your employer to see if your plan will let you add dependents.

If you have children and your plan will cover them, family plans are probably the way to go, but keep in mind the same considerations we explained above for married couples. If you and your spouse have single plans, compare your benefits to see which would be best for your children. Or, dual coverage is an option.

Families, like health insurance, are complex. Do your homework to see who’s covered and how much it’s going to cost.

Life-Changing Events

If you get married or have a baby, there’s usually a short window of time (usually 30 days) to add your spouse or child to your plan. Make sure you don’t miss the deadline and leave your loved one uninsured! Check with your employer to see when and how to change your plan benefits.

Find a Pediatrician Early

If you’re pregnant with your first child, you’ll need to find a pediatrician before you give birth. Some pediatricians won’t take your child as a patient if they didn’t go through an interview with you first. So be prepared – here’s a handy list of questions you may want to ask.

  1. Do you accept my insurance?
  2. Is this an individual or group practice? If it’s individual, who should I contact if you aren’t available? If it’s a group, how often will we see other doctors in the practice?
  3. How many years have you practiced as a pediatrician?
  4. Do you have any specialties?
  5. How can you be reached after hours?
  6. What are your office hours, as well as evening and weekend availability?
  7. Can I call in for routine/non-emergency issues?
  8. Which hospitals are you affiliated with?
  9. Do you see newborns at the hospital or at the first office visit?
  10. Does your office respond to e-mail?
  11. Does your practice have a website?
  12. How do you handle payments, billing, lab charges, and insurance claims?
  13. Will you be available to discuss behavioral developments?
  14. What are your views on issues like:
    • Circumcision?
    • Breastfeeding?
    • Immunizations?
    • Antibiotics?
    • Parenting methods?
    • Childhood obesity?
    • Alternative therapies?

Dual Coverage

Dual coverage can save you money ... but do your homework to be sure!

You have dual coverage if you are covered by two different health insurance plans. For example:

  • If you have two jobs: You could be covered by both employers.
  • If you’re married: You and your spouse could both be covered by both employers.

If you have children on both plans or you have a serious injury, illness, or long hospital stay, dual coverage could save you money. Coordination of benefits guidelines spell out which plan pays first and which plan pays second, but health insurance companies have their own rules for paying claims. You should review both plans' benefits and tell both plans that you have dual coverage.

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